Silicone And Saline Breast Implants

Once you decide to have breast augmentation surgery, a key decision is the type of breast implant that is best for you. Breast implants have two distinct parts. One is the shell. All breast implant shells are made of silicone, a rubber-like substance. Second is the fill material inside the shell. Breast implants are filled with either saline or silicone gel. Breast implants are made in a variety of shapes, sizes, surfaces, and fill materials. We have experience with all types of breast implants and will review all your options with you during your consultation and pre-operative visits. We use most types of implants, so be assured that we will help you decide which implant is best for your specific needs.

What Is Silicone?

Silicones are a family of chemical compounds. They are made from silicon, a naturally occurring element found in sand, quartz, and rock. Next to oxygen, silicon is the most common element in the earth's crust, and becomes silicone when it is combined with oxygen, carbon, and hydrogen. Depending on the arrangement of the molecules, silicones can be manufactured in a variety of forms, including oils, gels, and solids.

Silicones have been part of the consumer industry for over 50 years. Because they can be manufactured in various ways, silicones appear in a wide variety of products that most of us use every day. Hairsprays, suntan lotions, and moisturizing creams are just some of the consumer products that contain one form of silicone called dimethicone. The applications of silicone, whether used as an oil, gel, or solid, are equally extensive in the medical field. For example, the lubricating qualities of silicones make them ideal for coating surgical needles and suture thread, as well as the inside of syringes and bottles used for the storage of blood and intravenous medicines. Protective silicone coatings have also been used in pacemakers and heart valves. Other medical devices

utilizing silicones include: artificial joints, catheters, drainage systems, facial implants, tissue expanders, and breast implants. Silicone products have been shown to be biocompatible, reliable, flexible, and easy to sterilize, making them an excellent choice for both implantable and non-implantable medical devices.

photo of saline implant

This is a Natrelle™ breast implant from Allergan. This is a moderate profile saline breast implant. This implant has a smooth surface shell and a round shape. For illustrative purposes this implant is filled with air.

Saline-Filled Breast Implants

Saline breast implants are filled with a salt-water solution.

Saline is much like the fluid that makes up most of the human body. The outer shell of the implant is made of a silicone elastomer (a rubber-like material) and the fill material is the same sterile salt-water solution that is used for intravenous administration.

The breast implant is placed while empty and then filled with saline after it is in the breast. Saline breast implants have existed for decades and were the only breast implants available for routine breast augmentation during the silicone gel breast implant moratorium from 1992 to 2006.  All women over the age of 18, that are suitable candidates for breast augmentation surgery, are eligible for saline filled breast implants.

photo of a silicone gel implant

This is mid-range profile silicone gel Natrelle™ breast implant from Allergan. This implant has a smooth shell surface and round shape. This breast implant is filled with silicone gel.

Silicone Gel Breast Implants

Silicone gel breast implants have a silicone elastomer outer shell and are filled with a thick silicone gel.

The silicone gel inside the breast implant is a very thick material, similar to a thick gelatin. The silicone fill material is a "cohesive" substance, in that it is thick and does not run like a fluid.

However, though some now refer to all silicone implants as having a cohesive gel fill material, standard silicone gel implants do not have the truly cohesive gel that compromises the "form-stable" or, so-called "gummy bear", cohesive gel implants have.

In 1992 the FDA placed a moratorium on the use of silicone gel implants for routine breast augmentation. (At the same time, however, silicone gel breast implants were kept available for patients needing breast reconstruction, such as women with cancer surgery and congenital defects). The FDA silicone gel implant moratorium occurred in response to women's concerns about possible harmful effects of breast implants. While there was little, if any, scientific data to show that modern implants were harmful, the FDA placed a moratorium on the use of silicone gel implants for routine augmentation pending additional studies from the implant companies demonstrating the safety of the devices.

Meanwhile, in Europe and throughout most of the world, silicone implants continued to be used, developed, and improved.

After years of review of safety data accumulated since silicone gel implants were withdrawn by the FDA in 1992, the FDA concluded that silicone gel implants are a safe and appropriate option for women desiring routine breast augmentation. Final approval and release of silicone gel implants for use in all breast augmentation patients occurred in November of 2007.

In 2011 the FDA issued a follow-up report on the most recent data regarding the safety of silicone implants.  The recent data confirmed the earlier findings that silicone gel implants are safe for breast augmentation. 

All women over the age of 22, that are suitable candidates for breast augmentation surgery, are eligible for silicone gel filled breast implants.

Saline Versus Silicone Gel Breast Implants

Millions of women have had successful breast augmentations with saline and silicone breast implants. So, which breast implant is best for you? There is no single universal answer to this question and the decision must be customized to each woman's unique characteristics and desires. We break down the issue into four key points. One is the actual aesthetic appearance achieved. Two is the feel the breasts have after implantation. Three is the implications of implant failure. And, four is the impact of the implants on the maintenance of breast health.

Appearance Of The Augmented Breast

In most women, the overall shape and look of the breasts will be similar with either round saline or round silicone gel breast implants. However, there is a key distinguishing feature; the risk of implant visibility. When we talk about implant visibility, we are essentially referring to the visibility of the implant edges through deformation of the skin. Irregular appearing skin of augmented breasts is due to the ripples that are present on all implant edges.  Also, ripples can occur due to the internal traction from the implants on the skin, especially when one leans forward. Such visible implant rippling is most common at the outer part of the breasts, but it can occur anywhere.

During your consultation, we will show you saline and silicone gel filled breast implants and have you compare the ripples inherent to each type. On direct comparison, you will find that saline implants ripple more than silicone gel implants. So, do all women need silicone gel implants to avoid having visible ripples? The answer is no. In patients with moderate or thick soft tissue padding (that is, the skin, fat, and breast tissue layers) over the implants, visible ripples probably won't occur even with saline filled breast implants. In very thin patients, ripples probably will occur with saline implants and may even be seen with silicone gel implants. Based on your examination, soft tissue thickness and the size of implants you desire, Dr. Connall will be able to give you an estimate regarding your risk of visible implant ripples with both types of breast implants. 

Feel Of The Augmented Breast

The second key issue is: how do saline and silicone gel breast implants compare in terms of the feel of the augmented breast? In everyday life; when showering, dressings and exercising, both silicone gel and saline breast implants are soft and fluid and have a similar feel. The difference will most likely be noticed during a self breast exam or by your partner during intimate encounters.

In patients with thick soft tissue padding over the implants, the breasts will have a similar feel, though the mushier silicone gel implant may feel a bit softer and more natural than saline. In patients with thin or moderate soft tissue coverage, saline implants will be easier to feel than silicone gel implants. What is felt is the implant shell, which can feel like an irregular, bubble-edged bag within the breast. In most cases (except in thin patients) the shell of a silicone gel implant cannot be easily felt within the breast.

photo of implant ripple

This photo shows fine irregularities in the skin at the outside of the breast following breast augmentation. These ripples in the skin are from the deformation caused by the ripples in the breast implant shell. This patient is very thin and understood that such ripples would occur with her saline implants. Her tissues were so thin it is possible she would have had ripples even if silicone gel implants were used.

Breast Implant Failure

The third issue to consider is the difference in saline and silicone gel breast implants regarding the implications of implant failure. Both types of breast implants are very durable devices, but they are not perfect devices, so it is wise to assume that one or both implants will leak at some point in a woman's life. If a saline breast implant breaks, saline will leak from the implant. This saline is then absorbed naturally by the body. The implant will deflate rapidly and the smaller, deflated breast will usually be obvious in a day or two. When failure of a saline breast implant occurs, the tissues surrounding the implant are generally not affected. The deflated implant shell is very easy to remove during implant replacement surgery.

While there is little concern about complications due to saline implant failure, failure of a silicone gel breast implant may lead to reactions in and around the breast tissues. Older generation silicone gel implants had a more liquid-like gel which was prone to run throughout the soft tissue pocket surrounding the implant and, in some cases, even seep into the surrounding tissues. Such seeping of gel could lead to tissue reactions, such as formation of a nodular, silicone granuloma. The current generation of silicone gel breast implants are less likely to cause such local complications because the silicone is much thicker. If a current generation silicone gel implant breaks, the silicone gel inside the shell will bulge from the implant, but generally not run into the surrounding tissues. Therefore, local complications in and around the breast tissue from a leaking modern generation silicone gel implant, though perhaps possible, are unlikely to occur.

Maintenance Of Breast Health

The fourth issue is the difference between saline and silicone gel breast implants in terms of maintenance of breast health. There is a great difference between saline and silicone implants in ease of detection of an implant failure. With a saline breast implant a leak is usually obvious, since the implant deflates and the breast shrinks. The salt water from the implant is absorbed by the body naturally and is harmless. Therefore, special radiological studies, such as a MRI, are generally not needed to monitor or inspect saline filled breast implants.

However, when a silicone gel breast implant breaks, the breast usually maintains its shape, so the leak will not be obvious to the patient or a physician. In most cases, silicone gel implant failure can only be determined with an imaging study, such as an MRI. Since an MRI is the only reliable way to detect implant rupture, the FDA recommends that women with silicone gel implants obtain a MRI of their breasts three years after augmentation and every two years thereafter. And, since the FDA has not found the evidence to be conclusive that ruptured silicone gel implants are universally harmless, if a ruptured implant is detected, the FDA recommends for the implant to be removed and replaced (if desired by the patient).

Replacement of a silicone gel implant is similar to a saline implant, except that with silicone gel, some of the sticky gel material may need to be removed and cleansed from the soft tissue capsule around the implant. If this is necessary, it is generally not problematic to remove the free gel and it is of little consequence to the soft tissue capsule.

Breast Implant Selection

During your consultation, Dr. Connall will review all of your implant options with you in detail. He will frame your options in the context of your unique anatomical characteristics and personal desires. Only with a comprehensive consultation can you assess which implant is best for you. We look forward to helping you make this important decision about your breast augmentation.

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